In recent years, the concept of harm reduction has increased in popularity and is being applied in many contexts beyond drug use and sexual health. Today it is invoked in contexts as wide ranging as housing-first initiatives,11Bernadette Pauly et al., “Housing and harm reduction: What is the role of harm reduction in addressing homelessness?,” International Journal of Drug Policy 24, no. 4 (July 2013): 284-90, https://doi.org/10.1016/j.drugpo.2013.03.008. voting in electoral politics,22David Camfield, “Is voting really ‘harm reduction’?,” Briarpatch Magazine, July 2, 2019, https://briarpatchmagazine.com/articles/view/is-voting-really-harm-reduction. establishing a living wage,33adrienne marie brown, Pleasure Activism: The Politics of Feeling Good (Chico: AK Press,2019) “A good wage is the harm reduction of capitalism.” and suicide prevention. As long-time organizers and activist scholars, we have been interested in these evolving uses of the term and what effects they might have on its meaning. For example, looking closely at harm reduction in suicide prevention, we have witnessed harm reduction equated with mitigating the risk of self-harm through involuntary and carceral measures––often involving police––in the name of public health and safety. Ironically, this occurs despite well-documented evidence that police involvement in mental health emergencies increases the likelihood of harm to people, especially those who are Black and Indigenous.44Inayat Singh, “2020 already a particularly deadly year for people killed in police encounters, CBC research shows,” CBC News, July 23, 2020, https://newsinteractives.cbc.ca/fatalpoliceencounters. This is an illustrative example of how such uses of harm reduction, especially those that involve police, undermine its radical meaning and intent. This dissonance prompted the creation of the Radical Harm Reduction Project at the Critical Health and Social Action lab, which seeks to examine the evolving politics and practices of harm reduction initiatives across North America. In this brief article, we consider a specific area of the project: the incommensurability of police and harm reduction.
While there are many accounts of the history of harm reduction, we believe that there can be no history of harm reduction without centring the community organizing efforts of people who use drugs. As Christopher Smith reminds us, “before it was institutionalized as a public health policy…harm reduction originated as an illegal activity, where activists and politicized frontline workers risked arrest by distributing clean syringes.”55Christopher B.R. Smith, “Harm reduction as anarchist practice: a user’s guide to capitalism and addiction in North America,” Critical Public Health 22, no. 2 (June 2012): 209-221, https://doi.org/10.1080/09581596.2011.611487. Since then, many policies and practices have been labelled “harm reduction.” But it has consistently remained a radical practice of care and mutual aid in the face of governmental abandonment and criminalization, largely by communities experiencing the brunt of the HIV/AIDS epidemic, people who use drugs, queer and trans people, and sex workers.66Nancy E. Stoller, Lessons from the Damned: Queers, Whores and Junkies Respond to AIDS (New York: Routledge, 1998). For us, the concept and practice of harm reduction is rooted in a series of principles that emerge from its radical history. Within these, we include:
Pragmatism. Harm reduction recognizes activities deemed “illicit” and/or “illegal” will inevitably occur, and that all behaviours incur some risk. Therefore, responses that seek to eliminate risk through abstinence or criminalization actually serve to increase, rather than decrease, harm. Pragmatic approaches necessitate a focus on any and all actions that are effective in mitigating risk and reducing harmful effects.77Helen Keane, “Critiques of harm reduction, morality and the promise of human rights,” International Journal of Drug Policy 14, no. 3 (June 2003): 227-32, https://doi.org/10.1016/S0955-3959(02)00151-2.
Unconditionality. Harm reduction requires a commitment to non-judgment: there can be no preconditions for care. Effective strategies must “meet people where they are at,” enacting value neutrality and non-discrimination in the creation and delivery of interventions.
Autonomy. Related to unconditionality, harm reduction must be dedicated to respecting individual and community self-determination. Harm reduction therefore opposes all forms of coercive or compulsory intervention, and relies upon meaningful and consenting relationships of mutual aid.88Natalie Stoljar, “Disgust or Dignity? The Moral Basis of Harm Reduction,” Health Care Analysis 28, no. 4 (December 2020): 343-51, https://doi.org/10.1007/s10728-020-00412-y.
Community-Based. Against the prioritization of so-called experts and the process of evidence-making outside of communities, harm reduction centres the wisdom, leadership, and evaluation of people with lived and living experience.99Alana Klein, “Harm Reduction Works: Evidence and Inclusion in Drug Policy and Advocacy,” Health Care Analysis 28, no. 4 (December 2020): 404-14, https://doi.org/10.1007/s10728-020-00406-w; Christopher Smith and Zack Marshall, eds., Critical Approaches to Harm Reduction: Conflict, Institutionalization, (De-)Politicization, and Direct Action (Public Health in the 21st Century)(New York: Nova Science Publishers, 2016). At its core, harm reduction redistributes power to communities.
A Complex Understanding of Risk. Harm is never exclusively the product of individual behaviour, but the product of complex interactions between structures, systems, individual behaviours, and power relations in society. Harm reduction is therefore committed to addressing risk at multiple levels, and includes strategies that decrease individual health risks and address the broader conditions that produce risk environments.1010Tim Rhodes, “Risk environments and drug harms: A social science for harm reduction approach,” International Journal of Drug Policy 20, no. 3 (May 2009): 193-201, https://doi.org/10.1016/j.drugpo.2008.10.003; Bernadette Pauly, “Harm reduction through a social justice lens,” International Journal of Drug Policy 19, no. 1 (February 2008): 4-10, https://doi.org/10.1016/j.drugpo.2007.11.005.
With these principles in mind, we can more clearly articulate the ways in which harm reduction is necessarily opposed to the police, an inherently harmful institution wedded to the process of criminalization.
In our research, we have observed at least two major trends that attempt to reframe policing practices as “harm reduction.”
First, there is an increased rebranding of police reform as constituting a kind of “harm reduction.” For example, responding to critiques of racist police violence, police have adopted reforms such as the use of body cameras and incorporating implicit bias training into policing programs. Such measures have had little to no effect in reducing racist police violence, and they increase police budgets, but are justified because they “reduce harm.” Similarly, equity, diversity, and inclusion measures aimed at increasing representation of racialized peoples in police forces are broadly billed as a panacea to reduce harms associated with police violence in racialized communities, again lacking substantive evidence of reduced harm. Another example is the promotion of community-based policing models, meant to soften the public image of police, and provide greater discretion to police in their dealing with individuals engaged in illegalized behaviors.1111Marc Krupanski, “Police & Harm Reduction: How law enforcement can advance public safety, public health, and public confidence,” July 20, 2018, Open Society Foundations, https://www.opensocietyfoundations.org/publications/police-harm-reduction. While each of these reforms purport to reduce the harms of racist police and policing practices, they fail to uphold the principles of harm reduction outlined above and, in many cases, have been actively opposed by communities most subjected to police violence.
The second major trend is the incorporation of “harm reduction” into police mandates. The expansion of notions of public safety to include health service provision has meant the increased use of harm reduction interventions by police. Examples include the equipping and training of police with naloxone kits; mental health first-aid certification; or police distribution of sexual health resources. It also rebrands police as public health personnel, through the creation of mental health crisis units and the incorporation of police into networks of service provision and public health systems. A notable example emerged in 2021 when it was discovered that, despite being banned from the Pride Parade, the Toronto Police Service received training from Pride Toronto in harm reduction strategies aimed at “community safety” and were then contracted to provide harm reduction interventions during the 2022 festival. Against the better wisdom of communities directly affected by violent policing practices, the incorporation of systems of criminalization into contexts of health care increases risk.1212See, for example, Kelly Rose Pflug-Back, “Equipping police with naloxone may do more harm than good,” Ricochet, October 4, 2018, https://ricochet.media/en/2370/equipping-police-with-naloxone-may-do-more-harm-than-good. Risks include the likelihood of harm caused by police interaction (e.g., injuries, carding, arrests), as well as the systemic consequences of those interactions (e.g., police records being used in future legal proceedings, the impact of criminal records on employment). The involvement of police in domains traditionally run by communities and allied health service providers undermines a set of practices that have emerged despite criminalization and in the face of state abandonment.
These "harm reduction” approaches to policing––what we understand as a paradigm of harm reduction policing––fundamentally misappropriate the concept and may often produce an increased risk of harm. In other words, we do not believe that everything that purports to “reduce harm” constitutes harm reduction. In the realm of policing, reforms that try to “soften” their inherently violent role in society only function to further entrench police power in society. “Harm reduction policing” has the effect of obscuring the inherently violent function of police and, in doing so, increases the legitimacy, economic resources, and presence of police in our lives. The idea that police can be active participants in the work of harm reduction therefore represents a hollowing out of the concept’s radical history and principles. Sustained resistance to police co-option of harm reduction is necessary, and people’s lives depend on it. Echoing the work of many harm reduction organizers across North America, we believe that a key dimension of saving lives and improving collective well-being is opposing all forms of criminalization and judiciously resisting the involvement of police in our lives.
We argue that the only harm reductionist approach to police is abolition. In the negative sense, this means a dismantling of police, both within contexts of harm reduction and community health, as well as in society more broadly. As Geo Maher observes, “we live in a world of police, a society built around policing and that presumes their necessity” as a “one-size-fits-all solution for every social problem.”1313Geo Maher, A World Without Police: How Strong Communities Make Cops Obsolete (New York: Verso, 2021). The expansion of police into harm reduction spaces reflects this insidious reality. And people seeking access to harm reduction know full well that the role of police in these contexts is irredeemable. The answer, then, is not to improve police engagement in these spaces, but to dismantle and eliminate the presence of police altogether.
By demonstrating the ways that pragmatic and compassionate community care reduces harm, harm reduction reveals exactly why police are unnecessary to make life safer. As such, abolition is also an affirmation. As Ruth Wilson Gilmore suggests, it is about cultivating a greater presence, rather than absence, with each other.1414Ruth Wilson Gilmore, Abolition Geography: Essays Towards Liberation (New York: Verso, 2022). It is about building institutions and systems of support that have been historically denied to many communities. The work of abolition is about reducing our dependence on police by cultivating strong, connected, and self-determining communities that can collectively decide how to meet the needs of everyone and enhance individual and collective joy. This is what Angela Davis means when she similarly advocates for rendering prisons “obsolete”: not just a dismantling of prisons but the creation of alternatives that eliminate the need for prisons in the first place.1515Angela Y. Davis, Are Prisons Obsolete?, An Open Media Book (New York: Seven Stories Press, 2003). In the place of police, harm reduction invites us to build community-based responses1616For examples of such efforts, we would direct attention to the Indigenous-led Toronto Community Crisis Service Team pilot program, in collaboration with 2-Spirited People of the First Nations, the ENAGB Indigenous Youth Agency and Parkdale Queen West Community Health Centre; the Toronto Indigenous Harm Reduction; and Yúusnewas (YouthCO) programs, including Taking Care of Communities, taking care of Ourselves, and Culture Is Healing. that adequately empower people navigating varying forms of risk, in ways that are non-violent, non-criminalizing, and anti-oppressive.
For too long, police and the gnawing violence of their presence in our communities has persisted, subjecting us to unabating assaults on our lives. At its core, harm reduction is an affirmation of our right to life, unconditionally. In the face of police violence, and acknowledging that we diversely negotiate risk in a world that is unjustly structured, harm reduction is a life-affirming and power-building practice aimed at more than mere survival. It is not an injunction to live, but an invitation. Harm reduction is about our abiding together, and the belief that joy and freedom linger in the practice of mutual aid and collective struggle.